Resective epilepsy surgery is a viable option to help improve both seizure control and adaptive functioning in patients with Lennox-Gastaut syndrome, according to an article published in Pediatrics.
To evaluate the long-term outcomes for patients with Lennox-Gastaut syndrome who had undergone resective epilepsy surgery, researchers reviewed 90 patient case reports for surgeries performed at the Severance Children’s Hospital from 2003 to 2014 and managed them for at least 2 years following. Patients were between 3 and 23.5 years old at the time of surgery (mean±SD: 9.3±4.4) with 0.7 to 20.1 years from the time of first seizure to surgery (7.2±4.3). The most common pathologic finding was malformation of cortical development, which was noted in 62.3% (n=57) of patients.
Better social competence and adaptive behavior was achieved by seizure-free patients at post-surgery follow-ups compared with patients with persistent seizures
The study investigators concluded that “[c]areful preoperative investigations can be used to steer the course of LGS in patients toward seizure-free status and better outcomes in adaptive functioning and social competence. Resective surgery should be actively used to treat patients with LGS with suspected focal epileptic pathology.”
Kang JW, Eom S, Hong W, et al. Long-term outcome of resective epilepsy surgery in patients with Lennox-Gastaut syndrome [published online September 7, 2018]. Pediatrics. doi: 10.1542/peds.2018-0449
There is significant variation in the use of diagnostic testing and resective strategies among major epilepsy surgery centers practicing surgical resection in epileptogenic zones (EZ) in close proximity to or in the eloquent cortex (EC), according to results of a survey administered on behalf of the International League Against Epilepsy and published in Epilepsia.
Of the 40 survey respondents, 19 were from North America, 13 were from Europe, 3 were from Australia, 3 were from South America, and 2 were from Asia. Ultimately, 24 neurologists and 16 neurosurgeons responded. The survey comprised a total of 38 question categories that included 84 individual queries on the EZ, EC, plasticity, and resection strategies. The survey was designed to evaluate the weight assigned to diagnostic tests that are used to define the EZ and EC, how EC is viewed, and how surgeries are scheduled for foci that are near or in the EC. Respondents were required to assign weights of 1 to 5 to various diagnostic test findings.
A descriptive analysis revealed considerable variation in the use of diagnostic tests and resective strategies toward the EZ and the EC. This widespread variation in strategies may contribute to undesirable outcomes that are characterized by poor seizure control and added deficits.
The results of this survey underscore the need to establish best practices in pediatric epilepsy surgery. The data derived from this survey were used to devise a set of recommendations that will help minimize deficits and make certain that such deficits are reported consistently. Development of a scale that can be used to report deficits has also been proposed.
Jayakar P, Jayakar A, Libenson M, et al; Pediatric Epilepsy Surgery Task Force; International League Against Epilepsy. Epilepsy surgery near or in eloquent cortex in children-practice patterns and recommendations for minimizing and reporting deficits. Epilepsia. 2018;59:1484-1491.
Source: Article by S. Jacobs for Neurology Advisor
Medtronic plc (NYSE: MDT) announced today that the first procedure using the Visualase(TM) MRI-Guided Laser Ablation System has been performed in the pivotal SLATE (Stereotactic Laser Ablation for Temporal Lobe Epilepsy) clinical trial at Mayo Clinic in Rochester, Minn. (more…)
There are important, long-term gains from hastening the processes around surgical interventions against epilepsy – before the disease has had too much negative impact on brain functions and patients’ lives. These are some of the findings of a thesis for which more than 500 patients were studied and followed up. (more…)